Describe a good mnemonic to screen for major depressive episode SIGECAPS (5+ sx for at least 2 weeks Sleep - insomnia or hypersomnia every day Interest - decreased ability to experience pleasure Guilt - worthlessness or inappropriate guilt Energy - fatigue or loss of energy Concentration - decreased ability, indecisiveness Appetite - 5% change (up or down) without trying Psychomotor agitation or slowing - observable by others Suicidal - thought of, or attempts Describe some common describing phrases for the components of the mental status exam. ASEPTIC Appearance: grooming, stated age?, etc   -behaviour: activity level, tics, agitation, tremors Speech: Quantity, rate, quality Emotions:   -Mood: emotional state that the patient percieves   -Affect: flat, blunt, labile, content appropriate Perception:   -Hallucinations: sensory experience without reality (auditory, visual, auditory, etc)      -illusions are a misinterpretation of sensory input Thoughts:    -Content: Delusions (grandiose, religious, thought insertion, etc), obsessions, compulsions, phobias   -Process: coherent?, logical?, stream (goal oriented, circumstantial (comes back to point), tangential (doesn't), flight of ideas, loose associations Insight/Judgement:   -Insight: Do they know what is going on with them?   -Judgement: are they acting appropriately given the situation? Cognition: MMSE What are the 4 things you NEED to ask for any psychiatric consult?? PASS!!! Psychosis Abuse Substances Suicide Describe the three clusters of personality disorders Cluster A (MAD): Schizotypal (close to schizophren.), Schizoid (distant, anthony hopkins), Paranoid (suspect wife of cheating) Cluster B (BAD): Histrionic (daughter from married with children), Narcissistic (Sherlock), Borderline (fear of abandonment, intense relationships, "fatal attraction"), Antisocial (the Joker) Cluster C (SAD): Avoidant (afraid of neg evaluation, socially inhibited), Dependent (what about Bob), OCPD (med students) List the 6 anxiety disorders we talked about in class 1) Panic disorder 2) Specific phobia 3) Social Anxiety Disorder 4) GAD 5) OCD 6) PTSD Generally what are we using to treat anxiety disorders? 1) CBT for all 2) SSRI's (first line for all but specific phobia) 3) benzo's (specific phobia, after exposure therapy) RF's for elder abuse (6) >75 memory problems physical impairment substance abuse verbally or physically abusive depression DDx for dementia with prevalences Alheimer's (47%) Mixed (alz + vasc) (33.7%) Vascular (9%) LBD/Park dim (2.5%) FTD (5.4%) Pharma tmt for dementia 1) AChEi's for all 2) Memantine helps with AD only THESE ONLY TREAT SX Depression prevalence is higher or lower in the elderly? lower. All the depressed people have died Differentiate dementia and depression (4) Dementia vs Depression -Conceals vs highlighting health probs -insidius vs subacute onset -no psych hx vs hx of depression -stable vs variable cognitive loss TCA recommended for use in the elderly Nortryptiline Differentiate grief and depression (4 points) -worthlessness (D) -suicidal thoughts (D) -vegetative state (D) -want to be around others (G) What should you think of when you see a manic patient older than 65? Some other medical condition causing mania. BPAD has usually presented well before 65 Highest risk group for suicide? white males over 85 If someone comes in with new onset anxiety and are older than 65, what should you think? depression. Primary anxiety usually presents well before this. What kills you in anorexia? (3) suicide heat issues pancreatitis What is a huge thing you need to worry about in people with schitzophrenia? comorbid substance abuse (most are smokers) (47%) What is the 4 step approach to treating psychosis? 1) assessment 2) treatment setting (disposition) 3) non-pharm strategies 4) biological tmts Treatment phamacology for schizophrenia 1) Secong gen AP (e.g. rispiridone) (not clozapine!) or an oral 1st gen AP (if tolerated before) 2) another 2nd gen AP (not clozapine!) 3) 3rd 2nd gen AP OR clozapine Top 3 methods of suicide for Males and females ( just 2) Males: Hanging, poisoning, firearms Females: poisoning, hanging Some key points on suicide (3) -4 x more males than females -rates climb in the young and are stable in middle age -second most likely cause of death from 10-35 What are the big 3 disorders that put you at risk for suicide? -depression (75%) -substance abuse (25%) -Psychotic states (5%) 7 RF's for suicide -Male -age (seasons of suicide in your life) -FHx of suicide -Ethnicity (1st nations) -Previous self harm -current suicidal ideas -Psychiatric disorders (the big three) How do you screen for mania? DIG FAST (3+ is diagnostic) Distractibility Irresponsible behavior Grandiosity Flight of ideas Activity increased Sleep reduced Talkitiveness How do you screen for depression SIGECAPS (5+ for 2 weeks is diagnostic for major depressive disorder) Sleep probs Interest decreased Guilt or worthlessness Energy level decreased Concentration diminished Appetite changes Psychomotor changes Suicide thoughts How do you diagnose a panic disorder STUDENTS Fear the 3 C's (4+ and worry of additional attacks is diagnostic) Sweating Trembling Unsteadyness, dizziness Depersonalization Excess heart rate Nausea Tingling SOB Fear of dying, losing control 3 C's: Chest pains, Chills, Choking Prototypical SSRI citalopram